1508. Prevalence of Anal High Risk Human Papilloma Virus (hr-HPV) Infection and Cytological Abnormalities Among a Cohort of HIV Infected Men and Women in Central Massachusetts
Session: Poster Abstract Session: HIV and Co-infections
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • Anal dysplasia study IDSA poster.pdf (365.7 kB)
  • Background: Although anal HPV infection and cytological abnormalities are highly prevalent in HIV infected men who have sex with men (MSM), there is limited data on these abnormalities in HIV infected heterosexual men and women. Since November 2010 at our clinic, anal cancer screening with both hr-HPV and cytology was routinely performed in all HIV infected patients. The purpose of the study was to evaluate the prevalence of anal hr-HPV infection and cytological abnormalities among our cohort of HIV infected MSM, heterosexual men and women. We also evaluated the performance of hr-HPV and abnormal cytology in detecting high grade dysplasia (AIN2+).

    Methods: A retrospective study was conducted in HIV patients who underwent routine screening for anal cancer from January 2011 to January 2013. hr-HPV test is done concomitantly on anal cytology specimen that was placed in liquid-based ThinPrep (Cytyc, USA) using Hybrid Capture 2 assay (Digene Corporation). Medical records of patients who underwent high resolution anoscopy (HRA) because of abnormal cytology (ASCUS and above) or positive hr-HPV were reviewed.

    Results: A total of 221 HIV patients underwent screening with both hr-HPV and anal cytology.  Among them, 67% were men (73% MSM vs. 27% heterosexual) and 33% women. hr-HPV was positive in 43% (54% MSM, 28% heterosexual men, 27% women). Anal cytology was abnormal in 39% (48% MSM, 28% heterosexual men, 34% of women). Among 117(53%) patients with abnormal screening test, 27% had both hr-HPV infection and abnormal cytology, 14% had only hr-HPV infection and 13% had only abnormal cytology. Cytology results were normal in 50%, non-diagnostic in 10%, ASCUS in 23%, LSIL in 14% and HSIL in 2%. Among 68 HIV patients who underwent HRA because of either abnormal cytology or hr-HPV infection, 22 patients had AIN2+ (17 were MSM) and all had hr-HPV. None of 14 patients with negative hr-HPV who underwent HRA for abnormal cytology had AIN2+. Among 68 patients who underwent HRA, hr-HPV correlated better with AIN2+ compared to anal cytology (rs=0.35 vs. -0.03).

    Conclusion: Anal hr-HPV infection, cytological abnormalities and AIN2+ are prevalent among our cohort of HIV infected heterosexual men and women. We suggest anal cancer screening for all HIV infected patients. In our limited sample, hr-HPV performed better than anal cytology in detecting and ruling out AIN2+.

    Sumanth Gandra, MD, MPH1, Aline Azar, MD2, Nisha Kini, MPH3, Bruce Barton, PhD3 and Mireya Wessolossky, MD, MPH4, (1)Infectious Disease and Immunology, University of Massachusetts Medical School, Worcester, MA, (2)Medicine, University of Massachusetts Medical School, Worcester, MA, (3)Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, (4)Division of Infectious Disease and Immunology, University of Massachusetts Medical School, Worcester, MA

    Disclosures:

    S. Gandra, None

    A. Azar, None

    N. Kini, None

    B. Barton, None

    M. Wessolossky, None

    Findings in the abstracts are embargoed until 12:01 a.m. PST, Oct. 2nd with the exception of research findings presented at the IDWeek press conferences.